14 COGNITIVE THEORY AND RESEARCH ON ANXIETY
anxiety disorder later developed depression alone or depression comorbid with anxiety
at a 15-year follow-up (Merikangas et al., 2003). A Dutch longitudinal study of 3,107
older individuals found that 23% of subjects with an initial DSM-III anxiety disorder
continued to meet criteria 6 years later, whereas another 47% suffered from subclinical
anxiety (Schuurmans et al., 2005). It is evident the anxiety disorders persist for many
years when not treated (Craske, 2003). Given that the majority of these disorders have
their onset in childhood and adolescence (Newman et al., 1996), the chronic nature of
anxiety is a significant component of its overall disease burden.
Clinician Guideline 1.7
Consider the chronicity of anxiety and its inf luence on the development of other conditions
when conducting a cognitive assessment. We can expect that early onset and a more persis-
tent course would be more challenging for treatment.Consequences and Outcome
The presence of an anxiety disorder, or even just anxious symptoms, is associated with
a significant reduction in quality of life as well as in social and occupational function-
ing (Mendlowicz & Stein, 2000). In a meta- analytic review of 23 studies, Olatunji,
Cisler, and Tolin (2007) found that all individuals with anxiety disorders experienced
significantly poorer quality of life outcomes compared with control samples, and overall
quality of life impairment was equivalent across the anxiety disorders. Individuals with
an anxiety disorder have an increase in number of work loss days (Kessler & Frank,
1997; Olfson et al., 2000), more disability days (Andrews et al., 2001; Marcus, Olf-
son, Pincus, Shear, & Zarin, 1997; Weiller, Bisserbe, Maier, & LeCrubier, 1998), and
elevated rates of financial dependence in the form of disability payments, chronic unem-
ployment, or welfare payments (Leon, Portera, & Weissman, 1995). Anxiety also tends
table 1.2. select Culture-bound syndromes in Which anxious symptoms play a prominent role
Syndrome name Description Country
dhat Severe anxiety about the loss of semen through nocturnal
emissions, urination, or masturbation. (Sumathipala,
Siribaddana, & Bhugra, 2004)
Males in India, Sri
Lanka, Chinakoro Sudden and intense fear that one’s sexual organs will retract
into the abdomen eventually causing death. (APA, 2000)
Mainly occurs in males
in south and east Asiapa-leng Morbid fear of the cold and wind in which the individual
worries about further loss of body heat that could eventually
lead to death. The person wears several layers of clothes even
on warm days to keep out wind and cold. (Barlow, 2002)
Chinese culturestaijin kyofusho An intense fear that one’s body parts or functions are
displeasing, offensive, or embarrassing to other people by
their appearance, odor, facial expressions, or movements.
(APA, 2000).
Japan